Citation Nr: A25035991 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 221031-290478 DATE: April 18, 2025 ORDER Entitlement to service connection for residuals of pulled teeth is denied. FINDING OF FACT The Veteran does not have a current oral or dental disability for which service connection can be granted for Department of Veterans Affairs (VA) compensation purposes. CONCLUSION OF LAW The criteria for service connection for a dental disability for VA compensation purposes are not met. 38 U.S.C. §§ 1110, 1712, 5107; 38 C.F.R. §§ 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran honorably served in the United States Air Force from March 1969 to January 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2021 Appeals Modernization Act (AMA) rating decision issued by the VA Regional Office (RO) which is the agency of original jurisdiction (AOJ). In his October 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD), the Veteran elected the Hearing docket. A Board hearing was held by the undersigned Veterans Law Judge (VLJ) in January 2025. Therefore, the Board may only consider the evidence of record at the time of the November 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim adjudicated herein, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board has thoroughly reviewed the evidence of record in conjunction with this case. However, it has limited its discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Thus, the Board will summarize the relevant evidence where appropriate, and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. Lastly, all medical definitions utilized herein may be found at Dorland's Medical Dictionary Online. Entitlement to service connection for residuals of pulled teeth is denied. The Veteran seeks service connection for the residuals of pulled teeth. See July 2021 VA Form 21-526EZ, Application for Compensation. He contends that as a result of the extraction of his lower molars in service, his upper molars grow downwards and protrude into his mouth which has resulted in occlusal adjustments, trauma to the lower arch of his mouth, periodontal pathology, and difficulty chewing. See January 2025 Hearing Transcript. Typically, service connection is warranted for disability due to disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To substantiate a claim of service connection there must be competent evidence showing: (1) the existence of a claimed disability; (2) incurrence or aggravation of a disease or injury in active service; and (3) a causal relationship between the present claimed disability and the disease or injury incurred or aggravated during active service. Davidson v. Shinseki, 581 F.3d 1313, 1315-1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Dental and oral conditions which may be subject to compensation are listed under 38 C.F.R. § 4.150. These conditions include chronic osteomyelitis (inflammation of bone caused by infection), osteonecrosis (necrosis of bone due to obstruction of its blood supply), or osteoradionecrosis (necrosis of bone following irradiation) of the maxilla (the irregularly shaped bone that with its fellow forms the upper jaw; it assists in the formation of the orbit, the nasal cavity, and the palate, and lodges the upper teeth) or mandible (the horseshoe-shaped bone forming the lower jaw which articulate with the skull at the temporomandibular (TMD) joints) loss of whole or part of the mandible, including ramus (the parts of the mandible which articulate with the skull at the TMD joints), nonunion or malunion of the mandible, TMD disorder, loss of the condyloid (a bony projection that articulates with the temporal bone to form the TMD joint) or coronoid (a triangular, flat bony projection located on the superior part of the ramus) process, loss of any part of the hard palate (the anterior part of the palate, characterized by an osseous horizontal shelf, covered superiorly by mucous membrane of the nasal cavity and, inferiorly, by mucosa) loss of teeth due to loss of substance of body of maxilla or mandible without loss of continuity, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, and benign or malignant neoplasms of the hard and soft tissue. See 38 C.F.R. § 4.150, Diagnostic Codes (DCs) 9900-9918. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process (the portion of bone in either the maxilla or the mandible that surrounds and supports the teeth) as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, DC 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Id. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not compensable disabilities and will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. Service connection for purposes of outpatient dental treatment may be granted for a dental condition of any tooth and/or and periodontal tissue shown by the evidence to have been incurred in or aggravated by service so long as the Veteran falls under one of a number of specific classifications. See 38 C.F.R. § 3.381(a). For VA purposes, "service trauma" involves external, sudden-force injury, such as a combat wound to the teeth and jaw; it does not include the intended effects of treatment provided during military service. See VAOPGCPREC 5-97 (1997); Nielson v. Shinseki, 607 F.3d. 802 (Fed. Cir. 2010). Rating activity should consider each defective or missing tooth and each disease of the teeth and periodontal tissues separately to determine whether the condition was incurred or aggravated in line of duty during active service and, when applicable, to determine whether the condition is due to combat or other in-service trauma, or whether the Veteran was interned as a prisoner of war. 38 C.F.R. § 3.381(b). Careful analysis of the Veteran's service treatment records (STRs) do not show that the extraction of the Veteran's lower molars were due to combat or other in-service trauma. See March 1973 and August 2021 STRs. Thorough review of the Veteran's claims file reveals a June 2021 letter from the Veteran's dentist which states that as a result of the extraction of his lower molars, his upper molars have super erupted and caused an uneven plane of occlusion (the hypothetical horizontal plane formed by the contacting surfaces of the upper and lower teeth when the jaws are closed) resulting in trauma to the lower arch of his mouth, periodontal pathology, and difficulty chewing. See July 2021 Medical Treatment Record -Non-Government Facility. The Veteran's dentist suggested that possible treatments for his dental disabilities were occlusal adjustments and implants to replace the extracted lower molars. The Veteran testified during his January 2025 hearing that his current oral and dental disabilities are a result of dental treatment received in service. See January 2025 Hearing Transcript. The Veteran further detailed that as a result of these extractions, his upper teeth protrude lower into his mouth causing difficulty chewing and that he regularly bites his cheek, causing pain. During the in-person hearing, the Veteran brought a mold of his teeth. The undersigned VLJ described the Veteran's upper molars as having grown longer than normal. The Veteran stated that as a result of his missing lower molars, he had to regularly undergo treatments to shorten his upper molars to alleviate his symptoms. In support of his claim, the Veteran submitted a February 2023 letter from his treating dentist. See January 2025 Hearing Related. Therein, the Veteran's dentist recounted his reports that the Veteran had his lower molars (teeth #17 and teeth #18) removed during his military service and that as a result of the lower missing molars, his upper molars (teeth #15 and #16) had super erupted downwards, which resulted in occlusal adjustments, trauma to the lower arch of his mouth, periodontal pathology, and difficulty chewing. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110, 1131; Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). The requirement that a current disability be present is satisfied "when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim...even though the disability resolves prior to the Secretary's adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). To this end, the Board has carefully and sympathetically reviewed the Veteran's claims file. However, the evidence fails to show that the Veteran a current diagnosis of any oral or dental disability for which service-connected compensation may be granted. See 38 C.F.R. § 4.150, DCs 9900-9918. In the absence of proof of a current disability, there can be no valid claim for service connection. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In so finding, the Board finds the Veteran's lay statements and hearing testimony, together with the June 2021 and February 2023 letters from his treating dentist, to be the most probative evidence that the Veteran does not have a current diagnosis of an oral or dental disability which may be service connected during the appeal period. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). In denying the Veteran's claim of entitlement to service connection, the Board has greatly considered his lay statements and hearing testimony before the undersigned VLJ. His certainly competent to report the symptoms of his current oral and dental disabilities and the circumstances of his service, however, there is no evidence supporting a finding that he is medically competent to diagnose a complex dental disability nor provide a medical opinion regarding same. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Layno v. Brown, 6 Vet. App. 465, 469 (1994); 38 C.F.R. § 3.159(a)(1). The Veteran's lay statements are thus of less probative weight than the medical evidence which shows that he does not currently have an oral or dental disability which may be subject to VA compensation. Caluza, 7 Vet. App. 511-12. While reports of symptoms may lead to later diagnoses by medical professionals, here, the Veteran's lay statements have been investigated, diagnosed, and treated by his private dentist. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the Board finds that a VA examination and opinion is not necessary to decide the claims, and a remand to obtain a medical opinion, without evidence of an in-service occurrence or injury or an oral or dental diagnosis which may be service connected, would be futile and doing so would serve no useful or meaningful purpose and only instead result in imposing unnecessary and additional burdens on VA with no potential benefit flowing to the Veteran. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010); Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). While the Board is sympathetic to the Veteran's claim, he has not been diagnosed with a disability of the mouth or teeth for which service connection may be granted. There is thus no doubt herein to resolve, and the claim for service connection the residuals of pulled teeth must be denied as a matter of law. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (reasonable doubt to be resolved in Veteran's favor); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (the benefit-of-the-doubt rule applies if the competing evidence is in approximate balance); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). DUSTIN L. WARE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buntin, M.E. The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.